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The goal of simulation education is to strengthen health care performance in order to enhance patient care.
It was a moment of levity in the Mayo Clinic Multidisciplinary Simulation Center, a place where health care teams practice hands-on emergency, surgical and intensive-care interventions and techniques. It was tour day at the center, and the technician behind the two-way mirror was showcasing Stan's talents. "Stan" is short for standard patient simulator. More than a mannequin, Stan is programmed to give human-like responses to medications and treatments. For example, his breathing, blood pressure and pulse will change in response to intravenous drugs, defibrillation, intubation and a variety of other interventions. He can "bleed." He can even "die."
Stan is only one of many high-tech marvels in the Simulation Center, which is located at Mayo Clinic Rochester. The center opened in October 2005, and is one of the largest simulation centers in the world. It can operate 24/7 and is accessible to staff at any Mayo Clinic site. The Simulation Center provides national and international leadership in simulation teaching and is directed by William F. Dunn, M.D., a pulmonary and critical care specialist at Mayo Clinic Rochester and a world leader in simulation-based medical education.
In the last decade, a number of U.S. academic institutions have opened medical simulation education programs, but Mayo Clinic's multidisciplinary approach is distinctive. Here, teams of professionals from multiple specialties collaborate on program design and research. The Simulation Center is intended to serve as a catalyst to enhance teamwork.
The goal of simulation education is to strengthen health care performance in order to enhance patient care. Because Mayo's strength has always been in its cross-specialty teamwork, the Simulation Center can model this concept both in its educational focus and in its applications in patient safety and quality.
"How you communicate in a crisis is entirely different than in a controlled setting," says Roger W. Harms, M.D., chair, Mayo Clinic Rochester Education Committee. "We know the largest cause of medical errors in critical care medicine is not lack of medical knowledge, but errors in communication among critical health care teams. Simulation can help identify and address these gaps in communication among team members; the implications for improving care are profound."
"In critical care simulation exercises, your heart races, you sweat, you cope and you even go through grief if you lose the simulated patient," says Dr. Dunn. "There is an extraordinary power of insight with this experience."
That level of realism in a simulated exercise is created by Simulation Center staff who plan the scenarios. When a team of learners comes into the center, they enter an exact replica of their practice environment. "Within 60 seconds of the start of the exercise, the students are immersed in scenarios that demand quick thinking and skillful performance," says David R. Farley, M.D., professor of surgery at Mayo Clinic and coordinator of simulation surgery at the center.
Stan is usually the center of attention. During a simulation exercise, learners may intubate, resuscitate or medicate him and then monitor his response. Depending on the situation, students may give him anesthesia, perform a surgical procedure and then wake him again. All the while, realistic disruptions such as beeping pagers, ringing telephones and malfunctioning equipment are going on around them. It is all part of the planned exercise. And when the exercise ends, much of the real learning begins.
Following the simulation, the team reviews the exercise with a mentor. They discuss what happened, what went well and what could have gone better. They watch a video of the exercise to see themselves in action, and they discuss with their mentor what they learned individually and as a team.
Simulation learning is more than a simple hands-on experience using high-tech equipment; it's about being prepared. Simulation teaching allows for second chances or as many chances as students need to get it right. And Stan never complains. Most importantly, the simulated environment provides the experience needed without putting patients at risk. The experience helps instill a sense of confidence in the students. Just as aviation simulators help pilots learn to fly, simulators, like Stan, help health care professionals perfect their skills. So even though Stan may die today, he'll be reprogrammed tomorrow to face another day of heart attacks, emergency surgeries and lifesaving intubations.
The future of teaching surgery has arrived, and David R. Farley, M.D., director of the General Surgery Residency Program at Mayo Clinic, is greeting it with open arms. Gone are the days when he had to rely on uncommon or challenging cases to capture teachable moments in surgery. Now, thanks to the technology of Mayo Clinic Multidisciplinary Simulation Center, Dr. Farley brings these surgical challenges to the classroom in an event aptly named the Surgical Olympics.
The Surgical Olympics is an intense half-day surgical simulation event riddled with realism. Every general surgery resident participates. Given 15 minutes per learning station, the residents complete 10 or more designated stations. Racing from one action-packed scene to the next, they knot and suture, resuscitate, read scans and even take over a simulated surgical case already in progress. Every move and sound is videotaped as they analyze, problem solve, make decisions and try to keep their cool. As stressful as it sounds, it's part and parcel to the work of a surgeon. Dr. Farley uses aviation to explain how the Surgical Olympics helps prepare surgical residents for their life's work. "In aviation, if there's bad weather or dangerous conditions, controllers ground the airplanes, and pilots do not fly. Not so with surgery. Surgeons have no choice. They must perform surgery despite the conditions or level of stress," says Dr. Farley.
The Surgical Olympics was initiated in 2005. Since then, it has been conducted twice a year as both a learning and assessment tool, with more than 50 residents participating in each event.
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